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Effectiveness of universal newborn hearing screening: A systematic review and meta-analysis
Karen Edmond1, Shelly Chadha1, Cynthia Hunnicutt2
1World Health Organization, Geneva, Switzerland.
Insights
Universal newborn hearing screening (UNHS) programs identify permanent bilateral hearing loss (PBHL) earlier and may improve neurodevelopmental outcomes. These programs are recommended for global implementation to benefit all infants.
Area of Science:
- Pediatrics
- Public Health
- Audiology
Background:
- Permanent bilateral hearing loss (PBHL) affects at least 1 in 1000 newborns.
- There is a lack of recent systematic reviews on the effectiveness of universal newborn hearing screening (UNHS) programs.
- This study addresses the need for a comprehensive meta-analysis of UNHS effectiveness.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of universal newborn hearing screening (UNHS) programs.
- To assess the impact of UNHS on the identification of permanent bilateral hearing loss (PBHL).
- To evaluate the effect of UNHS on infant neurodevelopmental outcomes.
Main Methods:
- A systematic search of standard databases was conducted up to March 2022.
- Data from five studies involving over 1 million newborns were meta-analyzed using fixed and random effects models.
- The certainty of evidence was graded using standard methodologies, with the protocol registered on PROSPERO (CRD42020175451).
Main Results:
- UNHS significantly increased the likelihood of PBHL identification before nine months (RR 3.28, low certainty).
- PBHL was identified an average of 13.2 months earlier in infants with UNHS (very low certainty).
- UNHS showed potential benefits for receptive and expressive language development and overall development quotients (low to very low certainty evidence).
Conclusions:
- Universal newborn hearing screening programs lead to earlier detection of permanent bilateral hearing loss.
- UNHS may positively impact neurodevelopmental outcomes in infants.
- Implementation of UNHS is recommended globally across all income levels.
Background:
Permanent bilateral hearing loss (PBHL) is a serious condition in newborns, with a prevalence of at least one per 1000 live births. However, there has been no recent systematic review and meta-analysis of the effectiveness of universal newborn hearing screening programs (UNHS).
Methods:
We registered our study protocol on PROSPERO CRD42020175451. Primary outcomes were any identification of PBHL (ie, PBHL diagnosed at any time), age of identification of PBHL, and neurodevelopment. Two reviewers searched standard databases to March 2022 and extracted data. We used fixed and random effects meta-analysis to pool data and graded the certainty of evidence using standard methods.
Results:
The search retrieved 2834 records. We identified five studies reporting on the effects of UNHS vs no UNHS in 1 023 610 newborns. The relative risk of being identified with PBHL before nine months in infants with UNHS compared to infants without UNHS was 3.28 (95% confidence interval (95% CI) = 1.84, 5.85, one study, 1 023 497 newborns, low certainty evidence). The mean difference in the age of identification of PBHL in infants with UNHS compared to infants without UNHS was 13.2 months earlier (95% CI = -26.3, -0.01, two studies, 197 newborns, very low certainty evidence). The relative risk of infants eventually being identified with PBHL in infants with UNHS compared to infants without UNHS was 1.01 (95% CI = 0.89, 1.14, three studies, 1 023 497 newborns, low certainty evidence). At the latest follow-up at 3-8 years, the standardised mean difference (SMD) in receptive language development between infants with UNHS compared to infants without UNHS was 0.60 z scores (95% CI = 0.07, 1.13, one study, 101 children, low certainty evidence) and the mean difference in developmental quotients was 7.72 (95% CI = -0.03, 15.47, three studies, 334 children, very low certainty evidence). The SMD in expressive language development was 0.39 z scores (95% CI = -0.20, 0.97, one study, 87 children, low certainty evidence) and the mean difference in developmental quotients was 10.10 scores (95% CI = 1.47, 18.73, 3 studies, 334 children, very low certainty evidence).
Conclusions:
UNHS programs result in earlier identification of PBHL and may improve neurodevelopment. UNHS should be implemented across high-, middle-, and low-income countries.
Registration:
PROSPERO (CRD42020175451).
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